Method for producing osteosynthesis devices, osteosynthesis devices and implants made of semi-synthetic hybrid material obtained by structural modification of the components of a natural marine biomaterial

ABSTRACT

A semi-synthetic hybrid material having a pH from 7 to 7.4 includes an inorganic fraction and a cross-linked organic fraction. The method for producing this material, and osteosynthesis devices or implants made of semi-synthetic hybrid material are also described.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.14/592,156, filed Jan. 8, 2015, which claims benefit of U.S. ProvisionalPatent Application No. 61/925,753, filed Jan. 10, 2014, the entirecontents of which are incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to a semi-synthetic hybrid materialobtained by structural modification of the components of a naturalmarine biomaterial, in particular the nacreous aragonitic layer of valvesea mollusks such as Pinctada maxima, Pinctada margaritifera, Tridacnaemaxima, Tridacnae gigas and other Pinctada species. The presentinvention also relates to the production of osteosynthesis devices andimplants from said semi-synthetic hybrid material.

BACKGROUND

The method most commonly used on fractures, apart from the reductionthereof by external ways, is osteosynthesis, which involves realigningthe fractured segments by using plates, screws, nails and externalfixators, made of stainless steel or of alloys of titanium, cobalt,etc., so as to immobilize the fractured fragments in order to permit theformation of a fibrocartilage callus.

The presence of the orthopedic material throughout the period ofconsolidation creates new mechanical and metabolic conditions since, onthe one hand, the osteosynthesis material does not have the samemechanical and physical properties as the bone, especially Young'smodulus, bending strength, elasticity, hardness, density and since, onthe other hand, it suffers the corrosive action of the salineenvironment of the liquids circulating in the human body, which actionreleases metallic microparticles, ions, and various metal salts. This isfollowed by the appearance of inflammatory phenomena which may cause theformation of a fibrous envelope and may generate pain, edema, infection,fistulas, abscesses, bone resorption and sequestra at the periphery ofthe implant, which signs may appear several months after theimplantation of the material. Thus, in some patients in whom theorthopedic material was implanted only 2 years previously, it has beenpossible to observe, in tissue samples taken from around theosteosynthesis material, a relatively high rate of metallic inclusions,chronic inflammation, oxidoreduction reactions, galvanic corrosion,fibrosis, metallosis or tissue necrosis, which is explained by adegradation of the plates and the release of toxic metallic ions such ascobalt, aluminum, etc.

In view of the metallic nature of the osteosynthesis material, aninfection of the operating site may be difficult to treat generally,since the metal is impermeable by nature and thus opposes the diffusionof the therapeutic agent. It has also been possible to demonstrate that,during the bending of the plates in order to adapt them to thetopography of the bone contour at the implantation site, this causedfissures and incipient breaks aggravated by the action of thecirculating fluids and by the mechanical stresses, on account of thedifference in the physical and chemical characteristics of the bone andof the metal. In addition, several months or even several years afterthe surgery, it is sometimes possible to observe a migration of theplates due to the mobilization of the fixing screws, since the tribologyproperties of the metal may be difficult to modify in view of itsnature. Indeed, any modification of the surface state of the metal maymake it vulnerable to corrosion and may alter its mechanical properties.In order to improve the tribology properties of the osteosynthesismaterial and of the metallic implants, they have been covered with acoating of hydroxyapatite by a sintering method using a plasma torch, inorder to obtain the adhesion of metaplasic bone to the interface duringhealing of the bone. However, in most cases, the coating comes loose andfibrous tissue forms, which results in the mobilization of theosteosynthesis material or of the implants.

Originally, the osteosynthesis material was intended to be removed oncethe consolidation of the fracture had been confirmed clinically andradiologically. However, in a significant number of cases, theosteosynthesis material is left in place, since a new surgery in orderto remove it would necessitate further hospitalization and an surgeryalmost identical to the first one, with the usual complicationsassociated with any surgical intervention, a fortiori on bone. Indeed,the removal of the osteosynthesis material leaves a bone with drillholes and with a thinned cortex because of a lack of vascularizationcaused by the pressure of the plate. This results in secondary weakeningof the operating site with the possibility of fracture.

Some cases require the urgent removal of the osteosynthesis material,for the following reasons: complaints by the patient, localized pain,prominence of the material, localized infections, pseudarthrosis,migration and fracturing of the material, bone fracture around theimplant, toxicity and allergy.

Removal is also almost obligatory in the case of clavicle fracturesrequiring surgical management, because of the subcutaneous situation andthe presence of vessels and nerves such as the brachial plexus and thesubclavian artery, and the risk of pseudarthrosis resulting from theischemia caused by the pressure of the plate on a flat bone.

Removal is also essential in pediatric orthopedic surgery, which doesnot obey the same rules as those in adult surgery; in particular, whenthe fracture involves the epiphyseal-diaphyseal region of a long bone,this region in the child encompasses the metaphysis, the site of theconjugation cartilage responsible for the growth of bone. The continuedpresence of osteosynthesis material at this level over a too long periodof time will compromise the growth of the limb. These are the reasonswhy, in children, the orthopedic material is removed at an early stageso as to avoid this disadvantage. In doing so, one sometimes observespseudarthroses and fractures which are caused by weakening of the bone,not to mention the complications associated with the removal of thematerial.

It is also known that, during the treatment of a fracture byosteosynthesis, the process of bone consolidation is modified. Indeed,when implanting plates and screws made of metal, alloy or any othermaterial, it is necessary to evacuate the fracture hematoma even thoughit contains all the osteocompetent cells, and also molecules such as themitogenic substances, growth factors such as TGFβ, ubiquitousgrowth-regulating proteins, and likewise PDGF. This hematoma alsocontains the osteoinductive factors BMP, FGF, IGF, and also theimportant elements in the form of the pericytes which, released from thebasal lamina of the endothelium of the capillaries damaged by thefracture, become involved in the process of stimulation of angiogenesis,the synthesis of collagen, proteoglycans and osteocalcin, and in theinitiation of phagocytosis.

The absence of all these factors will considerably slow down theproduction of the bone callus. Moreover, given the fact that, during theconsolidation of an osteosynthesized fracture, the remodeling has tocontinue for at least 18 months, removal of the orthopedic materialbefore this date, for whatever reason, increases the risks ofcomplications such as fractures, pseudarthrosis or infection.

In conclusion, the removal of the osteosynthesis material, requiring anew surgery at a site that has already suffered trauma following a firstaggressive surgery on the bone and on the surrounding tissues, generatescicatricial changes which disturb the recovery ad integrum of theinitial anatomy and prevent the detection of the anatomical structures.All of this runs counter to the definition of osteosynthesis, which is amaneuver consisting of consolidating the fractured bone to theanatomical position without risking failure of the implant, all thisnotwithstanding the resulting socio-economic impact.

There is therefore a real need for osteosynthesis material that adjustsoptimally to the fracture site, that can be kept there permanently andoffers an alternative solution to the problems associated with thepresence and/or the removal of the existing metallic osteosynthesismaterial, such as toxic release, metallosis of the periprosthetictissues, systemic effects and weakening of the bone.

The inventors have shown that a material satisfying these needs can beobtained from a natural hybrid biomaterial which is the nacreousaragonitic layer of bivalve mollusks chosen from the group comprisingPinctada maxima, Pinctada margaritifera, Tridacnae maxima, Tridacnaegigas and other Pinctada species. They have also proven that thisbiomaterial can be used to produce osteosynthesis devices and implantssuch as: osteosynthesis plates and screws, osteotomy wedges, diabolos,intersomatic wedges and cages, intramedullary nails, humeral and femoralheads, glenoid cavities, tibial plateaus, femoral condyles, vertebralbodies, semi-maxillaries, bones of the ossicular chain, surgical anchorsfor ligament and/or tendon reinsertion, splints for osteosynthesizedreduction of small-fragment comminuted fractures, membrane retentionscrews and dental implants acting as permanent autologous grafts.

The nacreous aragonitic layer of bivalve mollusks chosen from the groupcomprising Pinctada maxima, Pinctada margaritifera, Tridacnae maxima,Tridacnae gigas and other Pinctada species is an organic and inorganiccomposite material of biogenic origin and of hybrid structure. Indeed,the nacreous aragonitic layer of these bivalve mollusks is presented inthe form of a layered architecture alternating between a mineralcomponent consisting of nanocrystals of aragonite, calcium carbonatecrystallized in the orthorhombic system, organized in sheets, and anorganic component consisting of linear and branched biopolymersorganized in a three-dimensional lattice. This assembly gives thebiomaterial a lamellar architecture particularly adapted to theabsorption and distribution of the forces and impacts opposing rupture.

It has been shown that the strength of a lamellar structure isassociated with the organic component, and the rigidity with the mineralcomponent, and that the polymers present the ideal structure forabsorbing and dissipating the energy-to-break. However, the process ofdevelopment and growth of the valves, especially of the nacreousaragonitic layer, may be modified due to endogenic factors, such as thephysiology and physiopathology, which differ from one mollusk toanother, and to exogenic factors such as the biotope, variations in themarine environment, the temperature of the water, the composition of thezooplankton and phytoplankton, the aggression of the pathogenic agentsand predators.

This results in an alteration of the macro-, micro- and nanometricarchitectural arrangement of the components and, consequently, of thequality of the aragonite, with repercussions on the mechanicalproperties which, for this reason, are not reproducible from one valveto another.

It has been possible to show by engineering that an arrangement ofstructures in a ratio of 10/1, that is to say a ratio of 400 nanometersof hard structures for 40 nanometers of soft structures, constituted thestandard for the production of hybrid lamellar structures, giving riseto the production of bioinspired synthetic materials of the aragonitictype, reproducing the alternating organization of organic-inorganicinterfaces, to obtain a three-dimensional material such as the marinearagonite of the mollusks mentionned above.

Moreover, the particular nature of the organic lattice, separating anduniting the inorganic sheets of aragonite, lies in the fact that it hasinterconnected pores of different diameters communicating throughout itsthickness, giving it a continuous porosity and an open porosity withopen pores.

Bone is a viscoelastic material of which the viscous character is due tothe presence of the interstitial fluids which impregnate it, andparticularly to that of the biopolymers such as the collagens,glyosaminoglycans and proteoglycans included in its composition.

The viscoelastic properties are more considerable in a fresh corticalbone, that is to say one impregnated with interstitial fluids (plasma,serum, etc.), than in dry bone. The same is true of the nacreousaragonitic layer of mollusks, the subject matter of the invention,which, even when dry, contains 2 to 3% water, mainly located in thebiopolymer layers of which it is composed.

French patent No. 09 54066 and U.S. Pat. No. 8,485,458 have describedhow the organic fraction of the nacreous aragonitic layer of the bivalvemollusks chosen from the groups comprising Pinctada maxima, Pinctadamargaritifera, Tridacnae maxima, Tridacnae gigas and other Pinctadaspecies, contains diffusible and soluble molecules having osteogenicproperties which are involved in the growth and mineralization ofcalcified tissues. It also contains biopolymers composed largely of typeI and II collagens, low molecular weight glycoproteins, of which someare related to growth factors, to cytokines and other osteocompetentmolecules involved in the regeneration of bone and/or cartilage. Thisorganic fraction also contains almost all the amino acids and inparticular arginine, glycine, aspartic acid, molecules havingchemotactic properties favoring cell adhesion, and also metalloenzymes,metalloporphyrins, metalloproteins, molecules involved in numerousmetabolic reactions during osteogenesis. In addition to the calciumcarbonate, the mineral fraction also contains numerous minerals, andalso metals involved in the biosynthesis of the calcified tissues.

The inventors have shown (C.R. Acad. Sc. Paris 1988, C.R. Acad. Sc.Paris 1989, CLINICAL MATERIAL 0267-6605/90/S03-50 1990) that thebiomaterial perpetuated itself at the endosseous site, forming a tightwelding with the receiving bone. Moreover, the active moleculescontained in the aragonite of the abovementioned mollusks have nocytotoxic effect, no mutagenic effect and no systemic effect, theirinteraction having only the impact of potentiating and stimulating localfactors of cicatrization and bone regeneration.

It has been possible to demonstrate in biomechanics, i.e. the study ofthe mechanical properties of the bones, that there was a closerelationship between their three-dimensional structure, their anatomicalpositioning and their functions. The spatial and temporal responses arethus adapted to the internal and external forces and stresses, the loadsapplied to the osseous structures being different depending on theirfunctions and their anatomical positioning.

The mechanical properties of the bones are therefore different dependingon their shapes, their functions and their relation to the differentmusculoskeletal levels. The values of the different types of measurementof strength, such as Young's modulus, flexural or compressive breakingstrength, elongation at break, thus vary depending on whether they areapplied to long bones, such as the femur, the tibia, the fibula, thehumerus, the radius and the cubitus, to short bones, such as those ofthe carpus, metacarpus, tarsus and metatarsus, to skeletal masses, suchas the vertebral bodies, the bones of the pelvis, and to the flat bones,such as those of the face and cranium, and also the clavicle andscapula.

It is also known that the behavior of the interface between the bone andthe osteosynthesis plate or implant is non-linear and that the loadsapplied are dynamic. This is why the behavior of an osteosynthesisdevice will be different depending on the anatomical positioning of thebone concerned.

It has also been demonstrated that the aragonite of the valves of thecited mollusks has mechanical properties for which the measurementparameters (Young's modulus, flexural or compressive breaking strength)have values which vary considerably and are clearly depending on thegeographical origin, the biotope, the variations in the marineenvironment, the temperature of the water, and the composition of thezooplankton and of the phytoplankton. It is possible to observe thatthere is a matching between the scale of diversity of the values ofthese parameters and that of the mechanical properties of the bone,depending on its function and its positioning, as is explained above.

For the production of osteosynthesis devices and/or implants made ofaragonite from the valves of the cited mollusks, the inventors thereforepropose selecting them, according to their origin and the cultureconditions, from the populations presenting values of mechanicalparameters compatible with and adapted to the purposes of theosteosynthesis devices and implants envisioned.

The inventors have shown that the osteoclastic activity, at the sourceof the osseous reorganization, took place in the same way in respect ofthe biomaterial, at the interface between the bone and the biomaterial,but was limited in time and coupled to the concomitant activity ofapposition of bone newly formed by the osteoblasts. In other words, thisbiological phenomenon confirms the osteomimetic nature of thebiomaterial and explains why, at the endosseous site, it joins to thereceiving bone.

Physiologically, one observes a release and stimulation, in situ, of allthe cellular signals and molecules necessary for inducing the biologicalcascade involved in the reorganization of the damaged host tissue.

Moreover, in the field of odontostomatology, where the losses ofsubstance are common after extraction, and in periodontal diseases wherethe use of bone substitute is proposed, the technique consists in usingresorbable or non-resorbable membranes, which requires the use ofretention screws, in most cases made of titanium or of stainless steel,in order to hold them in place and to form a space necessary to protectthe bone substitute below the membrane. It is known that maintaining abone filler material at the site is difficult, especially if it is inthe form of granules, since it is expelled through the incision line orthe fibrous mucosa. In order to maintain the filler material and themembrane in place, mini-screws made of titanium are used so as to form aspace above the zone that is to be filled. The protocol involvesremoving these screws after cicatrization and bone regeneration, withablation of the membrane if non-resorbable.

Similarly, in oral implantology, where most of the implants are made oftitanium oxide and zirconium, the same biological signs are observed aswith the osteosynthesis materials and the fixation screws, which signsare indicated above.

SUMMARY

For these reasons, the inventors have developed a novel semi-synthetichybrid material permitting the production of osteosynthesis devices andimplants intended to be kept permanently in place at the fracture site,such as: osteosynthesis plates and screws, osteotomy wedges, diabolos,intersomatic wedges and cages, intramedullary nails, humeral and femoralheads, glenoid cavities, tibial plateaus, femoral condyles, vertebralbodies, semi-maxillaries, bones of the ossicular chain, surgical anchorsfor ligament and/or tendon reinsertion, splints for osteosynthesizedreduction of small-fragment comminuted fractures, and also membraneretention screws and dental implants acting as permanent autologousgrafts.

Thus, the invention relates to a semi-synthetic hybrid material, whichis the nacreous aragonitic layer of bivalve mollusks chosen from thegroup comprising Pinctada maxima, Pinctada margaritifera, Tridacnaemaxima, Tridacnae gigas and other Pinctada species, wherein saidsemi-synthetic hybrid material comprises an inorganic fraction and across-linked organic fraction having a pH from 7 to 7.4. The presentinvention also relates to the method for obtaining this material bystructural modification of a natural hybrid biomaterial, which is thenacreous aragonitic layer of bivalve mollusks chosen from the groupcomprising Pinctada maxima, Pinctada margaritifera, Tridacnae maxima,Tridacnae gigas and other Pinctada species. The present invention alsorelates to the methods for producing osteosynthesis devices andimplants.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1a, 1b and 1c illustrate, respectively, a view of the outer face,a side view and a view of the inner face of a straight osteosynthesisplate.

FIGS. 2a, 2b and 2c illustrate, respectively, a view of the outer face,a side view and a view of the inner face of a epiphyseal-dialphysealosteosynthesis plate.

FIGS. 3a, 3b and 3c illustrate, respectively, a view of the outer face,a side view and a view of the inner face of a epiphyseal-dialphysealosteosynthesis break plate.

FIGS. 4a, 4b and 4c illustrate, respectively, a view of the outer face,an isometric view of the inner face and a side view of a osteosynthesisplate for malleolar fractures.

FIG. 5a illustrates the outer face of a half-sleeve of a splint forosteosynthesis of comminuted diaphyseal fractures.

FIG. 5b illustrates the inner face of a half-sleeve of a splint forosteosynthesis of comminuted diaphyseal fractures.

FIG. 5c illustrates the overall splint for osteosynthesis of comminuteddiaphyseal fractures assembled.

FIGS. 6a and 6b illustrate, respectively a view of a osteosynthesisscrew and a pitch.

FIG. 7 illustrates an overall view of a surgical anchor for ligamentand/or tendon reinsertion.

FIGS. 8a, 8b and 8c illustrate, respectively, the lower face, a sagittalsection and the upper face of an intersomatic cage.

FIGS. 9a and 9b illustrate, respectively, a front view and a side viewof an intramedullary nail.

FIG. 10 illustrates a view of a membrane retention screw.

FIGS. 11a and 11b illustrate, respectively, a sagittal section and anexploded view of a dental replacement implant.

DETAILED DESCRIPTION

According to a first aspect, the invention relates to a semi-synthetichybrid material which is the nacreous aragonitic layer of bivalvemollusks chosen from the group comprising Pinctada maxima, Pinctadamargaritifera, Tridacnae maxima, Tridacnae gigas and other Pinctadaspecies, wherein said semi-synthetic hybrid material said materialcomprising an inorganic fraction and a cross-linked organic fraction andhaving a pH from 7 to 7.4.

Due to its chemical composition, and its variable structural propertiesthat depend on the characteristics of its place of origin and culture,the semi-synthetic hybrid material of the invention has, particularly bycomparison with those of titanium or steel, suitable mechanicalproperties compatible with the different types of cortical bone.

The semi-synthetic hybrid material has a layered structure, i.e., asuperposition of inorganic fractions and organic fractions. Inparticular, the organic fraction does not include mineral inclusions.

The semi-synthetic hybrid material is not synthesized, but is obtainedby modification of the textural and structural properties of thenacreous aragonitic layer of bivalve mollusks chosen from the groupcomprising Pinctada maxima, Pinctada margaritifera, Tridacnae maxima,Tridacnae gigas and other Pinctada species, in particular a pHmodification and a cross-linkage of the organic layer.

The pH of the semi-synthetic hybrid material of the invention ismeasured on an aliquot of the material reduced to powder and dispersedin water. The pH of the semi-synthetic hybrid material of the inventionis close to the pH of the biological fluids and of the inner environment(which is at about 7.4), and this will allow the osteosynthesis devicesand/or implants produced from this material to be well tolerated andundergo a perfect biological integration. Moreover, such a pH createsconditions favoring the induction of cross-linking of the biopolymerchains of the organic fraction of the hybrid material.

The cross-linking is characterized by a multidirectional interconnectionof the chains of the linear and branched biopolymers constituting saidorganic fraction. The cross-linking induces a high cohesion energy, anincrease in the surface energy and, consequently, an increase in theadhesiveness and hydrophilicity of the semi-synthetic hybrid material ofthe invention. It also has the purpose of increasing the resistance ofthe organic fraction of the biomaterial to the corrosive action of thebiological fluids, by reducing its solubility and by opposing itsageing, and to the action of the mechanical stresses to which thebiomaterial is subjected.

These structural modifications also create conditions favoring theimpregnation of the osteosynthesis device and/or implant, produced fromthe semi-synthetic hybrid material of the invention, by biologicalliquids and/or compositions containing pharmaceutically activesubstances.

The invention also relates to a method for producing a semi-synthetichybrid material from a natural hybrid biomaterial, which comprises aninorganic fraction and an organic fraction, said method comprising astep of modifying the pH and a step of cross-linking the organicfraction of said hybrid biomaterial.

In the method of the invention, the natural hybrid biomaterial is thenacreous aragonitic layer of bivalve mollusks chosen from the groupcomprising Pinctada maxima, Pinctada margaritifera, Tridacnae maxima,Tridacnae gigas and other Pinctada species.

The mechanical tests carried out on samples of aragonite from thebivalve mollusks concerned, examining among other things Young's modulusor the breaking strenght, have shown that this biomaterial has,depending on its geographical origin and its culture conditions, a widerange of values compatible with the production of osteosynthesismaterial and implants depending on their purpose, that is to say thetype of bone concerned.

To ensure that, depending on the origin and the culture conditionsinitially found, the observed mechanical properties of the biomaterialare preserved around the mean values compatible with its use asosteosynthesis material and/or implant material for a type of boneconcerned, it was therefore necessary to find a method capable ofstructurally reinforcing the biomaterial so that its essentialmechanical properties are preserved according to the purpose of theosteosynthesis device and/or implant to produced.

According to the layered hybrid nature of the aragonite of thepreviously cited mollusks, the inventors thus propose to subject itsbiopolymer component to a specific polymeric treatment to modify thestructure of the aragonite, thus resulting in a reinforcement of itsmechanical properties.

Indeed, in engineering and in particular in the chemistry of polymerplastics, it has been shown that the cross-linking consolidates themechanical properties. This is why the inventors propose a method ofcross-linking, particularly by riboflavin, of the collagenic fractions,of the proteoglycans and glycosaminoglycans of the organic fraction ofthe valves of the cited mollusks, by reference to the cross-linking ofcorneal collagen, which is a biochemical fibrillar bridging by covalentbonds.

In order to be able to use the natural hybrid biomaterial for producingosteosynthesis devices and/or implants, the inventors have found that itwas important to consolidate its original mechanical properties bycross-linking the chains of the biopolymers composing its organicfraction. To do this, it was first of all necessary to lower its pH,generally of between 9 and 12, to a level of between 7 and 7.4, close tothat of the circulating biological fluids, thereby favoring thetolerance and biological integration of the osteosynthesis devicesand/or implants on and in the receiving site.

According to a particular embodiment, the step of modifying the pH isperformed by immersion in a bath of microbiologically controlled mainswater, brought to boiling point, for example in a mixture of equal partsof microbiologically controlled mains water and osmosed water, until thedesired pH is obtained. The treatment lasts, for example, for 60 to 180minutes, preferably 60 to 120 minutes. The pH can be measured on analiquot of the biomaterial reduced to powder and dispersed in water.

According to a particular embodiment, the cross-linking step isperformed with the aid of a cross-linking agent such as riboflavin,vitamin C, a polyol such as mannitol, and/or with the aid of physicalagents such as ionizing radiation.

The invention also relates to a method for producing an osteosynthesisdevice or implant made of semi-synthetic hybrid material as definedabove. Said method comprises the following steps:

-   -   a) selecting valves, having previously undergone exposure of        their nacreous aragonitic layer, of the mollusks chosen from the        group comprising Pinctada maxima, Pinctada margaritifera,        Tridacnae maxima, Tridacnae gigas and other Pinctada species,    -   b) cutting out pre-forms and producing the osteosynthesis        material, if appropriate after digital modeling,    -   c) modifying the pH and cross-linking, and    -   d) modifying the surface state, the order of steps b) and c)        being inconsequential.

Step a) involves selecting a mollusk valve according to its origin andits culture conditions, but also according to the purpose of theenvisioned osteosynthesis material, said valve having a thickness and aphysical and structural integrity that allow a pre-form of a sizeadapted to the envisioned device to be cut out from the previouslyexposed nacreous aragonitic layer.

In order to expose the nacreous aragonitic layer, the periostracum andthe external prismatic calcitic layer are ground by abrasion, inparticular with the aid of a fine-grain diamond wheel, for example at aspeed of 3,000 rpm under a stream of water. The thickness is measuredwith the aid of calipers. The physical and structural integrity of thearagonitic layer of the selected valve is checked in an optical chamber,for example with the aid of a halogen light source of 500 watt.

The valve is then brushed and washed under a stream of microbiologicallycontrolled mains water at a temperature of 55° C.

Step b) of cutting and production comprises, in a first phase, cuttingout pre-forms intended to produce osteosynthesis devices according topreviously imprinted contours, on one or the other of the faces of thevalve, to the dimensions of said devices.

According to a suitable embodiment, this cutting phase of step b) isperformed using a water jet charged with abrasive. The cutting with awater jet charged with abrasive has the advantage of not causingvibrations that may generate the start of microfractures, and of notcausing exothermic reactions capable of degrading the hybrid material.

Advantageously, the abrasive will be composed of grains of aragonite,thereby preventing any contamination of the material by a material ofanother nature.

For example, the cutting can be carried out in the following way: saidvalve is placed in suitable retaining frames, which are fixed on thebelt of a cutting machine, for example with 5 axes, using a water jetcharged with abrasive. The abrasive can be composed of grains ofaragonite with a grain size of between 0.1 and 200 μm. The water chargedwith abrasive grains is pulsed at a pressure of 4,000 to 6,200 bar, withthe aid of focusing guns of 0.50 to 1.2 mm in diameter, and cuttingnozzles of 0.12 to 0.40 mm in diameter.

The second phase of step b) involves production by precision-grinding orturning of the osteosynthesis devices and/or implants, optionally afterdigital modeling, permitting the exploitation of these data by digitallycontrolled machine tools.

According to a particular embodiment, the eventual insertion zone isdigitally modeled on the basis of anatomical components, such that thegeometry of the inner face of the osteosynthesis device or implant to beproduced adapts as closely as possible to the topography of this zone.The osteosynthesis device or implant is thus produced in a homologousmanner for a right or left limb.

According to another particular embodiment, drawings and sketches of thedevices are digitized in order to permit production thereof by turningor precision-grinding.

The phase of production by precision-grinding or turning in step b) canbe carried out, according to a particular embodiment, by means ofdigitally controlled machine tools using diamond-tipped or ceramicabrasive rotary instruments.

According to another particular embodiment, for the devices concerned,the phase of surface precision-grinding in step b) can be carried outwith the aid of a micro-cutting with a jet of charged water machinetool.

Step c) of modifying the pH and of cross-linking involves modifying thephysical and chemical properties of the hybrid material.

According to a particular embodiment, the modification of the pH in stepc) is performed by immersion in a bath of microbiologically controlledmains water, brought to boiling point, for example in a mixture of equalparts of microbiologically controlled mains water and osmosed water,until the desired pH is obtained. The treatment can last, for example,for 60 to 180 minutes, preferably for 60 to 120 minutes.

According to a particular embodiment, the cross-linking in step c) isperformed with the aid of a cross-linking agent such as riboflavin,vitamin C or a polyol such as mannitol. Classically, cross-linking isperformed at a temperature above 20° C. In the case where riboflavin isused, the impregnation of the hybrid biomaterial with the riboflavinwill advantageously be able to be followed by actinic exposure to UVA.The cross-linking can also be obtained by use of physical agents such asionizing radiation.

The inventors have favored the action of riboflavin, or vitamin B2, ascross-linking agent by virtue of its pharmacological, biochemical andphysical properties. Indeed Riboflavin very easily withstandssterilization and freezing and stimulates the cell metabolism.Considered as a cell growth factor, it is involved in the synthesis ofproteins, carbohydrates and lipids and has powerful antioxidantproperties, which oppose the action of the free radicals produced by theactinic action during cross-linking. It will thus be seen that the useof hydrosoluble riboflavin has the effect not only of modifying thestructure of the semi-synthetic material but also of conferring on itnovel pharmacological properties beneficial to bone regeneration andcicatrization.

Step d) involves modifying the surface state of said osteosynthesisdevice or implant by applying four successive treatments ofsandblasting, cleaning by ultrasound, cryogenics, and application ofnanoparticles. The objective is, on the one hand, to improve thetribology properties, especially the strong bonds of the covalent typeat the origin of the aggregation of the nanoparticles and of theirinteraction with the receiving medium, and, on the other hand, toincrease the surface/volume ratio between the device and the fracturedcortical bone in order to ensure the stability thereof, and finally topromote the release of the soluble osteogenerating molecules thatactivate the local factors of osteogenesis contained in them.

According to a particular embodiment, the sandblasting treatment in stepd) involves modifying the surface state of the osteosynthesis device orimplant in order to improve the anchoring thereof to the bone.

For example, it can be carried out in the following way: said device isplaced in a sandblaster and treated by being successively sprayed, withthe aid of an overpressure system, preferably with grains of aragonitemeasuring from 25 to 70 μm propelled with the aid of round sandblastingnozzles measuring 0.8 mm, and with grains of aragonite measuring from 70to 250 μm propelled with the aid of nozzles measuring 1.2 mm, at apressure of 6 bar.

According to a particular mode of treatment, the cleaning by ultrasoundin step d) is carried out as follows: an ultrasonic bath is filled withmicrobiologically controlled hot mains water, at 55° C., which is thetemperature of maximum efficiency, up to a marker indicating the desiredvolume of water. To this is added a cleaning and disinfecting solutionat a dilution of 1:128, i.e. 1 part of solution for 127 parts of water.After 15 minutes of degassing, intended to remove the air bubbles, theosteosynthesis device or implant is placed in the bath for a duration of30 minutes at a frequency of 40 kHz for a cavitation leading to optimalparticle removal.

Said device is then rinsed under a stream of microbiologicallycontrolled mains water for 20 minutes, then immersed for 20 minutes in abath of demineralized water at a temperature of 90° C., to which isadded 2% bleach at 2.6% active chloride for 30 minutes, then rinsedagain with demineralized water at 90° C.

Finally, the device is left to soak in demineralized water at 50° C., towhich is added liquid Calbénium®, or any other biocidal, virucidal orsurface-active agent diluted to 2%, for 30 minutes, rinsed, then dried.

According to a particular embodiment, the non-abrasive cryogenictreatment in step d), which is intended to prepare the faces of thedevice in contact with the cortical bone, involves spraying onto thesefaces small balls of dry ice of liquid nitrogen at −80° C. and measuring1 mm in diameter. The objective is to optimize the surface state by amechanical effect associated with a thermal shock, on account of thedifference in temperature between the surface to be treated and theballs of liquid nitrogen during the sublimation thereof upon impact.Inside a dedicated space, a mixture of compressed air and balls of iceare thus sprayed onto the one or more surfaces to be treated, at apressure permitting a non-abrasive treatment optimized by the lowhardness of the dry nitrogen ice, which is 2 Mohs.

According to the invention, the application phase of nanoparticles instep d) for modifying the surface state is a coating of mechanicallystructured nanoparticles that are obtained from the hybrid biomaterial,according to French patent No. 09 54066 and U.S. Pat. No. 8,485,458.

This phase of step d) for modifying the surface state is carried outeither by immersion in an emulsion of variable viscosity of saidmechanically structured nanoparticles, or by centrifugation, or byspraying, or, preferably, by electro-deposition, which involves plungingthe osteosynthesis devices and the implants into an electrolytic bath ofsaid nanoparticles, in such a way as to initiate an electro-depositionof said nanoparticles on the surface of the latter.

At the end of the physical and chemical treatments applied according tothe method of the invention, the aragonite of the mollusks concerned,constituting the devices produced according to the invention, can beconsidered to have been transformed into semi-synthetic hybrid material.

According to a particular embodiment, the method for producing anosteosynthesis device and/or implant additionally comprises a step e)involving impregnation thereof by biological liquids and/or compositionscontaining pharmaceutically active substances.

In order to standardize the viscoelastic properties of theosteosynthesis devices and implants produced according to the invention,the inventors therefore propose that the biopolymers included in theircomposition are impregnated with plasmas or serums of the differentantigenic systems of the blood groups, by soaking and/or impregnation,at atmospheric pressure or under vacuum, which additionally increasestheir biological acceptance.

In another preferred embodiment, the devices and implants can beimpregnated by medicinal substances such as non-steroidalanti-inflammatories, analgesics, antibiotics and antimitotics, or anyother substance having a therapeutic effect.

According to a particular embodiment, the method for producing a deviceadditionally comprises phases of packaging, for example in a doublepackaging, of sterilization, under a protective atmosphere, carried outwith the aid of ionizing radiation at 25 KGy, and also a storage step,either at a temperature of 0° to 4° C. or by freezing at −15° C., or,for the devices that have not been impregnated by the biologicalliquids, storage at ambient temperature.

The devices can also be impregnated extemporaneously with whole blood orautologous plasma at the time of the surgery.

The invention also relates to a device made of semi-synthetic hybridmaterial, or obtained according to the method for producing said device.Said device is chosen from among osteosynthesis plates, such as astraight osteosynthesis plate, an epiphyseal-diaphyseal osteosynthesisplate, an osteosynthesis plate for malleolar fractures, anepiphyseal-diaphyseal osteosynthesis break plate, osteosynthesis screws,membrane retention screws, osteotomy wedges, diabolos, intersomaticwedges and cages, intramedullary nails, humeral and femoral heads,glenoid cavities, tibial plateaus, femoral condyles, vertebral bodies,semi-maxillaries, bones of the ossicular chain, surgical anchors forligament and tendon reinsertion, splints for osteosynthesized reductionof small-fragment comminuted fractures, and dental implants.

According to a particular embodiment, the device has at least oneretention means which, during the positioning of said device, opposesthe displacement thereof, said means being chosen from among lockingpins, notches, a keyed and flattened harpoon, and a thread againstunscrewing.

According to the particular embodiment in which the retention means isformed by locking pins, these, being diametrically opposite, make itpossible to lock said device on the bone fragments on each side of thefracture line, after insertion wells have been formed in the corticalbone for the locking pins with the aid of a dummy plate, therebyproviding an immediate keyed primary fixation and a secondary fixationonce the bone cicatrization has taken place.

According to the particular embodiment in which the retention means isformed by transverse rectilinear notches in a step shape, these notches,by virtue of their geometry, oppose forward or rearward sliding of saiddevice.

According to the particular embodiment in which the retention means is aflattened keyed harpoon, the features of the latter oppose sliding androtation of said device.

According to the particular embodiment in which the retention means is athread, the latter has a geometry of non-metric pitch, and oftrapezoidal shape, which opposes its unscrewing.

Advantageously, this thread favors total filling of the windings by thenewly formed bone tissue.

According to a suitable embodiment, the device additionally comprisesfixation holes. The number, size and location of these fixation holeswill of course be adapted by the skilled person in accordance with theshape and dimensions of the device.

Said fixation holes can be milled, partially or entirely, and, ifappropriate, tapped with an ISO metric thread of standard pitch or finepitch.

According to a suitable embodiment, said fixation holes can be round oroblong and/or can form an acute angle with the vertical.

According to a particular embodiment, the device additionally comprisesa means which, during the positioning of said device, permits theadjustment thereof in such a way as to adapt optimally to the morphologyof the fracture site. According to a suitable embodiment, the meanswhich, during the positioning of the device, permits the adjustmentthereof is a bulge positioned on the inner face of said device with aheight of between 0.1 and 0.5 mm, preferably of between 0.15 and 0.25mm. It will be possible for this bulge to be ground as required justbefore the positioning.

According to a particular embodiment, the device, which is anepiphyseal-diaphyseal break plate, additionally comprises two V-shapedbreak notches, one on the outer face, the other on the inner face. Thebreak notch on the outer face of the device is easily detectable to thetouch and indicates the seat of the skin incision to be made. Saiddevice can then be broken with the aid of a hammer and a surgicalchisel, allowing the limb to continue its development, the two parts ofsaid device moving away from each other as the conjugation cartilageevolves.

During the surgerys, all the osteosynthesis material produced accordingto the invention is positioned with the aid of ancillaries, comprisingphantom plates made to the dimensions and to the characteristics of theosteosynthesis devices and having, among others, the followingaccessories: one or more drill bushes, depth gauges and holding gauges,drill bits and screw taps made to the dimensions of the screws, screwholders and plate holders, forceps for holding the fragments,screwdrivers and keys for hexagonal screw heads, distractors, openingwedges, holding wedges, etc.

The following examples illustrate the invention without implying anylimitation, and a person skilled in the art will be able to implementall the methods of the invention each time he wishes to produce anosteosynthesis device or an implant.

EXAMPLES Example 1: Method for Producing Osteosynthesis Devices

The valves from mollusks, in this example Pinctada maxima, which arechosen have a thickness, measured with the aid of calipers, sufficientfor producing the desired osteosynthesis devices.

The periostracum and the external prismatic calcitic layer are ground byabrasion, with the aid of a fine-grain diamond wheel, at a speed of3,000 rpm under a stream of water, which render possible the exposure ofthe nacreous aragonitic layer.

The physical and structural integrity of the chosen valves is checked inan optical chamber with the aid of a halogen light source of 500 watt.

The valves are then brushed and washed under a stream ofmicrobiologically controlled mains water at a temperature of 55° C.

In order to obtain pre-forms with the dimensions calculated according tothose of the osteosynthesis devices that are to be produced, thecontours are imprinted on one or other of the faces of the selectedvalves. The valves are then cut along the drawn contours. To do this,the valves are placed in suitable retaining frames, which are fixed onthe belt of a cutting machine with 5 axes, using a water jet chargedwith abrasive, for example grains of aragonite with a grain size ofabout 150 μm, pulsed at a pressure of 4,135 to 6,150 bar, with the aidof focusing guns of 0.50 to 1.2 mm in diameter, and cutting nozzles of0.20 to 0.40 mm in diameter.

Rough pre-forms are thus obtained.

To ensure that the geometry of the inner face of the osteosynthesisdevice adapts as closely as possible to the topography of its possiblezone of insertion, the latter is digitally modeled on an anatomicalpiece, by which means the osteosynthesis devices can be offered in anequivalent manner for a right or left limb.

The shapes and dimensions of the osteosynthesis devices are alsodigitally modeled from sketches. These digital data are then used inorder to allow the osteosynthesis devices to be manufactured byprecision-grinding or turning with the aid of digitally controlledmachines. The precision-grinding of the osteosynthesis pieces, exceptfor screws, can be carried out by application of a grinding processunder a current of water, using diamond-tipped or ceramic abrasiverotary instruments.

The osteosynthesis screws for their part can be obtained by a process ofturning under a current of water, with the aid of diamond-tipped orceramic abrasive rotary instruments. The osteosynthesis devices are thenimmersed in a bath comprising a mixture of equal parts ofmicrobiologically controlled mains water and osmosed water, brought toboiling point at 100° C., for a variable length of time depending ontheir thickness, for example 60 minutes, in order to bring the pH of theconstituent hybrid biomaterial to a value of between 7 and 7.4.

The osteosynthesis devices are then immersed in a 5% solution ofriboflavin for 48 hours, at a temperature in excess of 20° C., in orderto cross-link the biopolymer chains of the organic fraction of theconstituent hybrid biomaterial. The devices are then rinsed andthereafter placed for 20 minutes in a glass enclosure provided with UVAlamps with a wavelength of 365 nm, at an intensity of 2,300 μJ/cm². Theosteosynthesis devices are then dried with a current of hot air at 40°C.

Examination under a scanning electron microscope shows a densificationof the network of the biopolymer lattice of the constituent material.

In order to promote the anchoring of the osteosynthesis devicesproduced, the surface state of the parts intended to be in contact withthe bone is modified. As a first step, the faces and edges aresandblasted in a sandblaster, using an overpressure system, successivelywith round sandblasting nozzles of 0.8 mm, with grains of aragonitemeasuring from 25 to 70 μm, then with nozzles of 1.2 mm, with grains ofaragonite measuring from 70 to 250 μm, at a pressure of 6 bar.

The osteosynthesis devices are then treated by ultrasound as follows. Anultrasonic bath is filled with microbiologically controlled hot mainswater, at 55° C., which is the temperature of maximum efficiency, up toa marker indicating the desired volume of water. A cleaning anddisinfecting solution is then added at a dilution of 1:128, i.e. 1 partof solution for 127 parts of water. After 15 minutes of degassing,intended to remove the air bubbles, the osteosynthesis devices areplaced in the bath for a duration of 30 minutes at a frequency of 40 kHzfor a cavitation leading to an optimal particle removal.

The osteosynthesis devices are then rinsed under a stream ofmicrobiologically controlled mains water for 20 minutes, then immersedfor 20 minutes in a bath of demineralized water at a temperature of 90°C., to which is added 2% bleach at 2.6% active chloride for 30 minutes,then rinsed again with demineralized water at 90° C.

Finally, the osteosynthesis devices are left to soak in demineralizedwater at 50° C., to which is added a biocidal agent, for example liquidCalbénium®, or any other virucidal or surface-active agent diluted to2%, for 30 minutes, rinsed, then dried.

Two successive treatments are then carried out on the osteosynthesisdevices. The faces of the devices intended to be in contact with thecortical bone undergo non-abrasive cryogenic treatment. This treatmentconsists in the spraying of small balls of dry ice of liquid nitrogen at−80° C. and measuring 1 mm in diameter onto these faces, in order tooptimize the surface state by a mechanical effect associated with athermal shock, on account of the difference in temperature between thesurface to be treated and the balls of liquid nitrogen during thesublimation thereof upon impact. In this technique, a mixture ofcompressed air and balls of ice are sprayed onto the one or moresurfaces to be treated, at a pressure permitting a non-abrasivetreatment optimized by the low hardness of the dry liquid nitrogen ice,which is 2 Mohs.

The devices are then subjected to a treatment in which they are coatedwith mechanically structured nanoparticles, which are obtained from thehybrid biomaterial, according to the patents FR No. 09 54066 and U.S.Pat. No. 8,485,458, for example by electro-deposition, which involvesplunging the osteosynthesis devices into an electrolytic bath of saidnanoparticles, in such a way as to initiate an electro-deposition ofsaid nanoparticles on the surface of the osteosynthesis devices.

The osteosynthesis devices are then dried under a current of hot air at40° C. for 30 minutes, packed in double packaging, sterilized under aprotective atmosphere with the aid of ionizing radiation at 25 KGy, andstored at ambient temperature.

Example 2: Straight Osteosynthesis Plate

A straight osteosynthesis plate is obtained by the method described inExample 1. FIGS. 1a, 1b and 1c show, respectively, a view of the outerface, a side view and a view of the inner face of the straightosteosynthesis plate 1.

The straight osteosynthesis plate 1 is in the form of a parallelepipedof variable length, width and thickness. Its plane outer face, radiusedall round its perimeter, is pierced with several open fixation holes 2,3 of variable diameters, of which the most central one 3 is oblong inorder to permit translation of the plate depending on the topography ofthe fracture site. The open fixation holes 2, 3 are tapped on the lowerhalf of their height with an ISO metric thread of standard pitch or finepitch, corresponding to the thread under the head of the fixationscrews, and they are milled on their upper half. The outer edges of theplate are radiused all round the perimeter.

The inner face in contact with the bone has, along its entire length, arounded bulge 4 having a maximum thickness of 0.2 mm and encompassingthe screw fixation holes 2, 3.

This bulge is intended to allow the plate to be adjusted as closely aspossible to the anatomical variations of the insertion site. Indeed,osteology shows that the bone anatomy is reproducible from oneindividual to another; the differences concern the anatomical reliefsand features represented by the tuberosities, the tubercles, theapophyses, the grooves, the lines and the fossae, of which the shapesand volumes may vary by a few tenths of millimeters. Moreover, given thenature of the semi-synthetic material according to the invention, it ispossible during surgery to rework the surface of the bulge with the aidof a diamond-tipped rotary instrument under a stream of refrigeratedsterile water, so as to adjust the plate as closely as possible to thetopography of the insertion site, such that the interface between boneand plate is as intimate as possible.

On its inner face, the straight osteosynthesis plate 1 also has, alongits greatest dimensions, two locking pins 5 of trapezoidal shape and ofvariable dimensions, one in the upper third, the other in the lowerthird, and which are diametrically opposite. The function of theselocking pins is to lock the plate on the bone fragments on either sideof the fracture line after insertion wells for the locking pins havebeen formed in the cortical bone with the aid of the dummy plate,thereby producing an immediate keyed primary fixation and a secondaryfixation once the bone cicatrization has taken place.

Example 3: Epiphyseal-Diaphyseal Osteosynthesis Plate

An epiphyseal-diaphyseal osteosynthesis plate is obtained by the methoddescribed in Example 1. FIGS. 2a, 2b and 2c show, respectively, a viewof the outer face, a side view and a view of the inner face of theepiphyseal-dialphyseal osteosynthesis plate 6.

The T-shaped epiphyseal-diaphyseal osteosynthesis plate 6 has ahorizontal epiphyseal part of variable length, height and thickness,curved forward and inward in such a way as to match the meta-epiphysealtopography.

It is pierced with open fixation holes 7, 8 of variable number (three inFIG. 2a ) and diameter, which are milled on their upper half and tappedon their lower half with a standard or fine ISO metric pitch.

The central fixation hole 8 of variable dimensions is oblong, in orderto permit translation according to the requirements.

The vertical diaphyseal bar, which is of variable dimensions and has aslight convexity downward, inward and forward, matching the topographyof the diaphyseal relief, is pierced with open fixation holes 9, 10 ofvariable number (three in FIG. 2a ) and diameter, of which the centralhole 10 is oblong in order to permit translation, if necessary, beforetightening of the screws. These holes are milled in their upper half andtapped on the lower half with a standard or fine ISO metric pitch.

The outer edges of the plate are radiused all round the perimeter.

The outer faces of the epiphyseal and diaphyseal bars are plane.

The inner faces comprise a rounded bulge 11 having a maximum height of0.2 mm and encompassing the fixation holes 7, 8, 9 and 10. They alsohave two locking pins 12, 13 which act as keys in the cortical bone andwhich are diametrically opposite, of trapezoidal shape and of variabledimensions, one 12 on the rear vertical edge of the epiphyseal bar, theother 13 in the lower third of the front edge of the diaphyseal bar,thereby opposing the rotation and shifting of the distal and proximalfragments of the fractured bone.

Example 4: Epiphyseal-Diaphyseal Osteosynthesis Break Plate

An epiphyseal-diaphyseal osteosynthesis break plate is obtained by themethod described in Example 1. FIGS. 3a, 3b and 3c show, respectively, aview of the outer face, a side view and a view of the inner face of theepiphyseal-dialphyseal osteosynthesis break plate 14. This break plateis intended for use in pediatric surgery.

The epiphyseal-diaphyseal osteosynthesis break plate 14 is in the shapeof a T of variable dimensions and is similar in all its features to theplate for adults in Example 3, and it also has on its two faces, at thejunction between the horizontal bar and the vertical bar, two V-shapednotches 15 affecting the edges.

The horizontal and vertical bars are pierced with open fixation holes16, 17 of variable number and diameter, which are milled on their upperhalf and tapped on their lower half with a standard or fine ISO metricpitch.

The central fixation hole 17 of the horizontal and vertical bars ofvariable dimensions is oblong, in order to permit translation accordingto the requirements.

The outer edges of the plate are radiused all round the perimeter.

The outer faces of the horizontal and vertical bars are plane.

The inner faces (shown in FIG. 3c ) of the horizontal bar and of thevertical bar each comprise a rounded bulge 18 having a maximum height of0.2 mm and encompassing the fixation holes 16, 17. They also have twolocking pins 19, 20 which act as keys in the cortical bone and which arediametrically opposite, of trapezoidal shape and of variable dimensions,one 19 on the rear vertical edge of the horizontal bar, the other 20 inthe lower third of the front edge of the vertical bar, thereby opposingthe rotation and shifting of the distal and proximal fragments of thefractured bone.

The V-shaped notches 15 situated at the junction of the horizontal barand of the vertical bar allow the plate to be broken into two parts.These notches will be easily detected by touch and will indicate thesite where the skin incision is to be made.

The plate will then be able to be broken with the aid of a hammer and asurgical chisel, allowing the limb to continue its development, the twoparts of the osteosynthesis material moving away from each other as theconjugation cartilage evolves.

Example 5: Osteosynthesis Plate for Malleolar Fractures

An osteosynthesis plate for malleolar fractures is obtained by themethod described in Example 1. FIGS. 4a, 4b and 4c show, respectively, aview of the outer face, an isometric view of the inner face and a sideview of the osteosynthesis plate 21 for malleolar fractures. Theosteosynthesis plate 21 for malleolar fractures has the general shape ofa parallelepiped of variable length and width, of which the lower end isconvex rearward and upward along half of its length and radiused allround its perimeter.

Its inner face is forwardly concave and, at each end, has locking pins22 of trapezoidal shape and of variable dimensions. The locking pinsituated at the lower end is positioned in such a way as to fastenitself on the lower end of the styloid process once the fracture hasbeen reduced.

The plate is pierced with fixation holes 23, 24, 25, which are variablein number depending on its length, and radiused all round its perimeter.

The most central hole 24 is of oblong shape in order to permit possibletranslation. The lower and last fixing hole 25 forms an angle of 15°with the vertical in order to permit fixation of the styloid process onthe distal part of the fibula with bicortical support.

Example 6: Splint for Osteosynthesis of Comminuted Diaphyseal Fractures

A splint for osteosynthesis of comminuted diaphyseal fractures isobtained by the method described in Example 1. It is shown in FIGS. 5a,5b and 5c . It is composed of two parts, being two half-sleeves 26, 27which are machined on the basis of modeling of the possible zones ofinsertion of the osteosynthesis device. The outer face of thehalf-sleeve 26 is shown in FIG. 5a , and the inner face of thehalf-sleeve 27 is shown in FIG. 5b . The overall splint assembled fromthe two half-sleeves is shown in FIG. 5 c.

The half-sleeve 26 is in the shape of a semicylinder of variablediameter and length, its outer face is convex over its entire height,pierced with open fixation holes 28 which are of variable number anddiameter and which are aligned on the longitudinal edges of the splintand are offset with respect to each other in such a way that thefixation screws intersect. The fixation holes 28 are tapped on the innerhalf of their height with an ISO metric pitch and are milled on theother half. The inner face is concave over its entire height; it has,along the longitudinal edges, two diametrically opposite notches 29, onein the upper third, the other in the lower third.

The other half-sleeve 27 is machined on the basis of digital modeling ofthe equivalent zone of the half-sleeve 26 and is of generally triangularsection, adapting to the bone morphology of the diaphyseal zone inquestion. It has a length and a thickness comparable to those of thehalf-sleeve 26 and is pierced with open fixation holes 30 which aretapped over their entire height with the ISO metric pitch correspondingto the thread of the end of the fixation screws. These holes are pairedup with the holes 28 of the half-sleeve 26 and are diametricallyopposite. Along its longitudinal and diametrically opposite edges, ithas two locking pins 31 of variable dimensions, corresponding to thenotches 29 of the half-sleeve 26.

FIG. 5c shows the two half-sleeves joined together, the locking pins 31of the half-sleeve 27 being fixed in the notches 29 of the half-sleeve26.

The two half-sleeves 26, 27 are beveled in such a way as to conform toeach other during osteosynthesis, and their upper and lower edges areradiused.

Example 7: Osteosynthesis Screw

An osteosynthesis screw is obtained by the method equivalent to thatdescribed in Example 1. FIG. 6a shows a view of the osteosynthesis screw32.

The osteosynthesis screw 32 has an overall cylindrical shape composed ofa thread and of a head, which are of different diameters and of variabledimensions.

The upper end 39 of the screw is milled and surmounted by a hexagonaldevice 40 allowing it to be screwed using a suitable ancillary tool.

The part 33 below the head is threaded with a standard or fine ISOmetric pitch corresponding to the pitch of the inner part of thefixation holes of the plates.

The part 34 of the screw below the ISO metric thread is threaded with aparticular pitch and has a geometry suitable, on the one hand, foropposing unscrewing and, on the other hand, for promoting the completefilling of the windings by the newly formed bone tissue.

This pitch is shown in FIG. 6b . With a depth 35 of 0.40 mm, it has theshape of a trapezoid of which the inward and downward oblique upper side36 forms an angle of about 135° with the upper end of the thread bottom37, and of which the inward and downward oblique side 38 forms an angleof about 80° with the lower end of the thread bottom 37.

Example 8: Surgical Anchor for Ligament and/or Tendon Reinsertion

A surgical anchor for ligament and/or tendon reinsertion is obtained bythe method described in Example 1. FIG. 7 shows an overall view of thesurgical anchor 41 for ligament and/or tendon reinsertion.

The surgical anchor 41 for ligament and/or tendon reinsertion has anoverall cylindrical shape and has, on the lower two thirds, a thread 42,such as described in FIG. 6b , opposing unscrewing.

The upper third, starting from the upper limit of the thread 42, has acircular constriction 43 of variable depth and height, surmounted by aquadrilateral 44 with radiused corners, having on its four faces arounded depression 45 of variable diameter.

The quadrilateral 44 is surmounted by a hexagonal structure 46 ofvariable height, inscribed within the perimeter thereof.

Example 9: Intersomatic Cage

An intersomatic cage is obtained by the method described in Example 1.FIGS. 8a, 8b and 8c show, respectively, the lower face, a sagittalsection and the upper face of the intersomatic cage 47.

The intersomatic cage 47 has the general shape of a parallelepiped witha trapezoidal base and of variable dimensions, of which the central partis pierced by an open orifice 48 of variable diameter, dovetailed in thetransverse direction.

The plane upper face has two transverse rectilinear notches 49, 50 witha step shape, one 49 at a distance from and in front of the front edgeof the central orifice, the other 50 at a distance from and behind therear edge of the latter. These notches oppose forward sliding of thecage.

The plane lower face also has two notches 51, 52 inclined downward andrearward, one 51 at a distance from the front edge of the centralorifice, the other 52 at a distance from the rear edge of the latter,opposing rearward sliding of the cage.

The upper face is machined at a predetermined angle depending on thesite of the diskectomy and in such a way as to re-establish cervical orlumbar lordosis.

The plane front face, of variable dimensions, is pierced at its centerby a fixation hole 53 which is tapped with an ISO metric pitch and is ofvariable depth and diameter, intended to receive firstly thecage-holding screw driver and secondly the fixation screw for theosteosynthesis plate.

The rear face, of variable height, has a rounded central depression 54intended to be positioned opposite the yellow ligament.

All the edges and corners of the upper and lower faces of theintersomatic cage 47 are radiused.

Example 10: Intramedullary Nail

An intramedullary nail is obtained by the method described in Example 1.FIGS. 9a and 9b show, respectively, a front view and a side view of theintramedullary nail 55.

The intramedullary nail 55 is in the shape of a cylinder of variablediameter and length and, at both ends, has two or more through-orifices56 allowing it to be keyed in place with the aid of bicortical supportscrews.

The lower end 57 is harpoon-shaped and has two diametrically oppositeflats 58.

The upper end 59 is rounded and flattened at the center so as to allowimpaction, and it has, all round its diameter, a shoulder 60 withradiused perimeter.

Example 11: Membrane Retention Screw

A membrane retention screw is obtained by the method described inExample 1. FIG. 10 shows a front view of the membrane retention screw61.

The membrane retention screw 61 is in the form of a cylindrical screw ofvariable length and diameter, has a thread 62 as described in FIG. 6band is surmounted by a hexagonal head 63 of variable height anddiameter. The screw pitch makes it possible to oppose tearing-out whenthe screw is placed in cortical bone or deficient alveolar bone.

Example 12: Dental Replacement Implant

A dental replacement implant is obtained by the method described inExample 1. FIGS. 11a and 11b show, respectively, a sagittal section andan exploded view of the dental replacement implant 64.

The dental replacement implant 64 comprises a cylindrical body 65 ofvariable length and diameter, having a thread opposing unscrewing, suchas the one described in FIG. 6b . The body 65 is provided, in its upperthird, with a ring 66 of Dacron® felt intended to promote fibroblastcolonization and producing a genuine gingival setting all round itsperimeter, thereby delimiting a gingival attachment zone and a freepseudo-gingiva, opposing migration of the oral fluids and foodparticles.

This device also has a resilient disk 67, a cap 68, and a pre-prostheticabutment 69, which elements are made of biocompatible polymer and areintended to receive the prosthetic restoration.

Example 13: Clinical Results

The method of Example 1 is used to prepare 6 T-shapedepiphyseal-diaphyseal plates with 4 open holes, of which the epiphysealbar measures 15 mm×8 mm×3 mm and of which the diaphyseal bar measures 12mm×9 mm×3 mm, and fixation screws according to Example 7, of length 33mm and of diameter 3 mm, which are sterilized by ionizing radiation at25 KGy in double packaging. These plates are fixed to the outer face ofthe metaphyseal-epiphyseal region of the tibia of 6 ewes according to acodified surgical protocol.

The animals are anesthetized according to the normal protocol: sodiumthiopental (IV) at approximately 1 g/animal, maintenance with isoflurane1.7-6-1.8% and ketamine prior to the pain phases. After incision of thecutaneous plane and dissection of the musculo-aponeurotic layer andperiosteum, the surface of the cortical bone is exposed.

With the aid of a dummy plate provided with drill bushings and placed onthe chosen insertion zone, the fixation orifices for the screws of theosteosynthesis material and the locking pins are drilled. After removalof the dummy plate, the fixation orifices are tapped in a manner openfrom cortical to cortical.

The plate is positioned and maintained in place by support gauges andfixed by the screws by way of the support gauges.

After hemostasis, the deep-lying planes are sutured with resorbablesuture threads, the cutaneous plane with non-resorbable threads. Thelatter are removed after 10 days of cicatrization.

X-rays are taken at D+30 and D+60, and the anatomical pieces are removedat D+60 from three ewes and at D+120 from the other three ewes.

Clinical examination of the anatomical pieces shows that the plates andthe screws are perfectly integrated, covered by periosteum.

After translocation, the plates and the head of the screws appearopalescent, imbibed with plasma and adhering to the cortical bone of thebone.

Macroscopic examination shows a modification of the hue of theosteosynthesis plates, and also the presence of a suffusion ofamber-yellow liquid, similar to plasma, during sectioning of the plate.

This observation suggests that, during the contact of the plate with thecortical bone and the circulating fluids, the biopolymer layers havebeen impregnated by these via the interconnected pores of thesemi-synthetic hybrid material.

Histomorphometric examination of the interfaces between plate andcortical bone and between screw and endosteum shows an anfractuouslacunary erosion of the inner face of the plate and of the windings ofthe screws, colonized by osteoblasts, apposition of a subperiostealmetasplasic bone, and significant thickening of the endosteum.

The interface between screw and cortical bone and between screw andmedullary cavity shows the same images, namely a lacunary erosion at thesurface along the windings of the screws and over the entire lengththereof, with apposition of newly formed fresh bone, which suggests thatthe mesenchymatous strain cells of the bone marrow are the cause ofthis, with induction of bone-growth-promoting activity.

All of these observations indicate an interactive biological activitybetween the semi-synthetic hybrid material according to the inventionand the receiving bone.

Indeed, it has been demonstrated that the initial presence ofosteoclastic giant cells, which are found near the screws in themedullary cavity, are formed by fusion and measure up to 100 μm andderived from the same precursor cells as the monocytes, shows that theyare responsible for the formation of crevice-shaped lacunae at thesurface of the screws. These crevices can be compared to Howship'slacunae, which are characteristic of osteoclastic activity and indicatebone remodeling. In other words, these observations explain theosteomimetic properties of the plate and of the osteosynthesis screws orimplants according to the invention.

All of these features of the semi-synthetic hybrid material of theinvention permit an alternative solution to the problems associated withthe presence and/or removal of the metallic osteosynthesis material,such as release of toxins, metallosis of the tissues around theprosthesis, systemic effects, weakening of the bone, etc.

This justifies the concept of permanent osteosynthesis material, nolonger requiring the removal of the orthopedic material for whateverreason.

The invention claimed is:
 1. A semi-synthetic hybrid material, which isthe nacreous aragonitic layer of bivalve mollusks selected from thegroup consisting of Pinctada maxima, Pinctada margaritifera, Tridacnaemaxima, Tridacnae gigas and other Pinctada species, said materialcomprising an inorganic fraction and a cross-linked organic fractionhaving cross-linking biopolymer chains formed by cross-linkingbiopolymer chains with the aid of a cross-linking agent and a physicalagent, and said material having a pH from 7 to 7.4.
 2. An osteosynthesisdevice or implant made of semi-synthetic hybrid material as defined inclaim 1, which is chosen from osteosynthesis devices such as a straightosteosynthesis plate, an epiphyseal-diaphyseal osteosynthesis plate, anosteosynthesis plate for malleolar fractures, an epiphyseal-diaphysealosteosynthesis break plate; osteosynthesis screws; membrane retentionscrews; osteotomy wedges; diabolos; intersomatic wedges and cages;intramedullary nails; humeral and femoral heads; glenoid cavities;tibial plateaus; femoral condyles; vertebral bodies; semi-maxillaries;bones of the ossicular chain; surgical anchors for ligament and/ortendon reinsertion; splints for osteosynthesized reduction ofsmall-fragment comminuted fractures, and dental implants.
 3. The deviceaccording to claim 2, said device comprises at least one retention meanswhich, during the positioning of said device, opposes the displacementthereof, said retention means being chosen from among a pin, a notch, akeyed and flattened harpoon, a thread against unscrewing.
 4. The deviceaccording to claim 2, wherein said device further comprises anadjustment element which, during the positioning of said device, permitscoaptation thereof.
 5. The device according to claim 2, which is anepiphyseal-diaphyseal osteosynthesis break plate and which comprises abreak notch.